Janine Stevens 2009
Cardiovascular disease is a significant cause of preventable morbidity and mortality in New Zealand and thus is an important public health problem. Early detection of people at increased risk through primary care-based cardiovascular risk assessment is a key step in primary prevention strategies to reduce the impact of cardiovascular disease for all New Zealanders.
This dissertation aims to explore the views of general practitioners, Primary Health Organisations (PHOs), and consumers, regarding the acceptability of cardiovascular risk assessment by community pharmacists.
A mixture of qualitative and quantitative research methods are used. The views of four Christchurch general practitioners are examined in a focus group discussion and the attitudes of key informants from three Canterbury PHOs are obtained through semi-structured individual interviews. Constant comparative analysis is used to code and categorise the collected data and identify dominant themes. A quantitative questionnaire-based pilot survey is used to collect the opinions of 34 consumers in two areas of Christchurch. The utility of the questionnaire as a data collection tool is assessed and preliminary statistical analyses are undertaken to describe the opinions of the surveyed consumers.
Contrasting views between the three key stakeholder groups regarding the provision of cardiovascular risk assessment services by community pharmacists were found. General practitioners were generally opposed to development of such a service, PHO key informants were more open to the potential benefits as well as risks, and consumers tended to support the concept. Common concerns expressed by all three groups included perceived lack of privacy in a community pharmacies and uncertainty regarding the level of clinical training of pharmacists. General practitioners voiced strong opinions regarding the potential for competition with community pharmacists for services traditionally provided through general practice and contrasting views about access advantages for pharmacy-delivered services were revealed amongst the three key stakeholder groups. Other important issues raised included boundary encroachment, the need for better communication and collaboration between general practitioners and community pharmacists, problems with fragmentation of care, commercial pressures, and resource implications.
There are mixed views amongst general practitioners, PHOs, and consumers regarding the acceptability of cardiovascular risk assessment by community pharmacists. Exploration of the reasoning behind these views indicated that pharmacist-led cardiovascular risk assessment services are often seen to offer advantages of improved access and convenience, but considerable work is needed to improve inter-professional relationships and develop effective methods of information sharing and referral to facilitate collaboration between primary care health professionals on this important public health issue. In addition, privacy issues within community pharmacies must be addressed, appropriate training for community pharmacists needs to be developed to ensure competency in all aspects of cardiovascular risk assessment and referral before pharmacist-led cardiovascular risk assessment services are offered, and funding options must be explored to support the development and implementation of such an initiative. More research is also recommended to further clarify and substantiate the views of general practitioners, potential funders, and consumers obtained in the current study and to further enrich our understanding of perceptions of key stakeholder groups towards pharmacist-led cardiovascular risk assessment services.